流行病学研究中的样本代表性问题(一)
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摘要
研究的样本代表性一直是流行病学领域内具有争议性的话题之一。本文首先对流行病学样本代表性进行定义,同时对研究人群、源人群、目标人群、内部真实性、外部真实性等相关流行病学基本概念进行阐述。在此基础上,本文深入分析了横断面研究、队列研究、病例对照研究、干预性研究四种主要流行病学研究设计中样本代表性的价值和实际可行性。总而言之,除针对人群疾病或健康现状的横断面研究外,多数涉及病因或干预效果推断的流行病学研究不应过度强调样本代表性。
Representativeness has long been a contentious topic in epidemiology. The review starts with defining representativeness in epidemiology and describing fundamental epidemiological concepts including study population,source population,target population,internal validity,and external validity. In addition,it elaborates the role and practicality of representativeness in four major epidemiological study designs including cross-sectional,cohort,case-control,and intervention studies. In summary,representativeness is an important consideration in cross-sectional studies of investigating disease or health status in the target population,but cannot be overstated in epidemiological studies for causal inferences regarding exposure-outcome relationships or intervention effects.
Representativeness has long been a contentious topic in epidemiology. The review starts with defining representativeness in epidemiology and describing fundamental epidemiological concepts including study population,source population,target population,internal validity,and external validity. In addition,it elaborates the role and practicality of representativeness in four major epidemiological study designs including cross-sectional,cohort,case-control,and intervention studies. In summary,representativeness is an important consideration in cross-sectional studies of investigating disease or health status in the target population,but cannot be overstated in epidemiological studies for causal inferences regarding exposure-outcome relationships or intervention effects.
引文
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[4]Tsao CW,Vasan RS.Cohort Profile:The Framingham Heart Study(FHS):overview of milestones in cardiovascular epidemiology[J].Int J Epidemiol,2015,44(6):1800-1813.DOI:10.1093/ije/dyv337.
[5]Rothman KJ,Greenland S.Validity and generalizability in epidemiologic studies[J].Encyclopedia of Biostatistics,2005.DOI:10.1002/0470011815.b2a03129.
[6]Ponsonby AL,Dwyer T,Couper D.Is this finding relevant?Generalisation and epidemiology[J].Aust N Z J Public Health,1996,20(1):54-56.
[7]Rothman KJ,Greenland S,Lash LL.Modern Epidemiology[M].(Third edition)Australia:Lippincott Williams&Wilkins,2012.
[8]Rothman KJ,Gallacher JE,Hatch EE.Why representativeness should be avoided.[J].Int J Epidemiol,2013,42(4):1012-1014.DOI:10.1093/ije/dys223.
[9]Wang L,Gao P,Zhang M,et al.Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J].JAMA,2017,317(24):2515-2523.DOI:10.1001/jama.2017.7596.
[10]Fang L,Gao P,Bao H,et al.Chronic obstructive pulmonary disease in China:a nationwide prevalence study[J].Lancet Respir Med,2018,6(6):421-430.DOI:10.1016/S2213-2600(18)30103-30106.
[11]Wang W,Jiang B,Sun H,et al.Prevalence,incidence,and mortality of stroke in China:results from a nationwide populationbased survey of 480 687 adults[J].Circulation,2017,135(8):759-771.DOI:10.1161/CIRCULATIONAHA.116.025250.
[12]Schooling CM,Jones HE.Is representativeness the right question?[J].Int J Epidemiol,2014,43(2):631-632.DOI:10.1093/ije/dyt264.
[13]中国疾病预防控制中心营养与健康所.中国居民营养与健康状况监测项目简介[EB/OL].(2015-05-05)[2018-09-03]http://www.chinanutri.cn/gzrw_132/zgjmyyyjkzkjcxm/201505/t20150505_114496.html.Institute of nutrition and health,Chinese center for disease control and prevention.Introduction to nutrition and health monitoring project for Chinese residents[EB/OL].(2015-05-05)[2018-09-03]http://www.chinanutri.cn/gzrw_132/zgjmyyyjkzkjcxm/201505/t20150505_114496.html.
[14]National Center for Health Statistics.National Health and Nutrition Examination Survey.[EB/OL].(2013-09-30)[2018-09-04]https://www.cdc.gov/nchs/nhanes/index.htm.
[15]Doll R,Hill AB.The mortality of doctors in relation to their smoking habits:a preliminary report[J].Br Med J,1954,1(4877):1451-1455.DOI:10.1136/bmj.328.7455.1529.
[16]Colditz GA,Philpott SE,Hankinson SE.The impact of the Nurses’Health Study on population health:prevention,translation,and control[J].Am J Public Health,2016,106(9):1540-1545.DOI:10.2105/AJPH.2016.303343.
[17]Rimm EB,Stampfer MJ,Colditz GA,et al.Effectiveness of various mailing strategies among nonrespondents in a prospective cohort study[J].Am J Epidemiol,1990,131(6):1068-1071.
[18]Keyes KM,Galea S.Epidemiology matters:a new introduction to methodological foundations[M].USA:Oxford University Press,2014.
[19]Pizzi C,De Stavola B,Merletti F,et al.Sample selection and validity of exposure-disease association estimates in cohort studies[J].J Epidemiol Community Health,2011,65(5):407-411.DOI:10.1136/jech.2009.107185.
[20]Szklo M,Nieto FJ,Miller D.Epidemiology:beyond the basics[M].USA:Oxford University Press,2001.
[21]Zang EA,Wynder EL.Differences in lung cancer risk between men and women:examination of the evidence[J].J Natl Cancer Inst 1996,88(3-4):183-192.
[22]Carneiro I,Howard N.Introduction to epidmeiology(Second edition)[M].UK:Open University Press,2011.
[23]Schulz KF,Grimes DA.Case-control studies:research in reverse[J].Lancet,2002,359(9304):431-434.
[24]Kopec JA,Esdaile JM.Bias in case-control studies.A review[J].J Epidemiol Community Health,1990,44(3):179-186.
[25]Wacholder S,Mc Laughlin JK,Silverman DT,et al.Selection of controls in case-control studies.I.Principles[J].Am J Epidemiol,1992,135(9):1019-1028.
[26]Wacholder S,Silverman DT,Mc Laughlin JK,et al.Selection of controls in case-control studies.II.Types of controls[J].Am JEpidemiol.1992,135(9):1029-1041.
[27]Frieden TR.Evidence for health decision making-beyond randomized,controlled trials[J].N Engl J Med,2017,377(5):465-475.DOI:10.1056/NEJMra1614394.
[28]Stuart EA,Bradshaw CP,Leaf PJ.Assessing the generalizability of randomized trial results to target populations[J].Prev Sci,2015,16(3):475-485.DOI:10.1007/s11121-014-0513-z.
[2]Nohr EA,Olsen J.Commentary:Epidemiologists have debated representativeness for more than 40 years--has the time come to move on?[J].Int J Epidemiol,2013,42(4):1016-1017.DOI:10.1093/ije/dyt102.
[3]Checkoway H,Pearce N,Kriebel D.Selecting appropriate study designs to address specific research questions in occupational epidemiology[J].Occup Environ Med,2007,64(9):633-638.DOI:10.1136/oem.2006.029967.
[4]Tsao CW,Vasan RS.Cohort Profile:The Framingham Heart Study(FHS):overview of milestones in cardiovascular epidemiology[J].Int J Epidemiol,2015,44(6):1800-1813.DOI:10.1093/ije/dyv337.
[5]Rothman KJ,Greenland S.Validity and generalizability in epidemiologic studies[J].Encyclopedia of Biostatistics,2005.DOI:10.1002/0470011815.b2a03129.
[6]Ponsonby AL,Dwyer T,Couper D.Is this finding relevant?Generalisation and epidemiology[J].Aust N Z J Public Health,1996,20(1):54-56.
[7]Rothman KJ,Greenland S,Lash LL.Modern Epidemiology[M].(Third edition)Australia:Lippincott Williams&Wilkins,2012.
[8]Rothman KJ,Gallacher JE,Hatch EE.Why representativeness should be avoided.[J].Int J Epidemiol,2013,42(4):1012-1014.DOI:10.1093/ije/dys223.
[9]Wang L,Gao P,Zhang M,et al.Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J].JAMA,2017,317(24):2515-2523.DOI:10.1001/jama.2017.7596.
[10]Fang L,Gao P,Bao H,et al.Chronic obstructive pulmonary disease in China:a nationwide prevalence study[J].Lancet Respir Med,2018,6(6):421-430.DOI:10.1016/S2213-2600(18)30103-30106.
[11]Wang W,Jiang B,Sun H,et al.Prevalence,incidence,and mortality of stroke in China:results from a nationwide populationbased survey of 480 687 adults[J].Circulation,2017,135(8):759-771.DOI:10.1161/CIRCULATIONAHA.116.025250.
[12]Schooling CM,Jones HE.Is representativeness the right question?[J].Int J Epidemiol,2014,43(2):631-632.DOI:10.1093/ije/dyt264.
[13]中国疾病预防控制中心营养与健康所.中国居民营养与健康状况监测项目简介[EB/OL].(2015-05-05)[2018-09-03]http://www.chinanutri.cn/gzrw_132/zgjmyyyjkzkjcxm/201505/t20150505_114496.html.Institute of nutrition and health,Chinese center for disease control and prevention.Introduction to nutrition and health monitoring project for Chinese residents[EB/OL].(2015-05-05)[2018-09-03]http://www.chinanutri.cn/gzrw_132/zgjmyyyjkzkjcxm/201505/t20150505_114496.html.
[14]National Center for Health Statistics.National Health and Nutrition Examination Survey.[EB/OL].(2013-09-30)[2018-09-04]https://www.cdc.gov/nchs/nhanes/index.htm.
[15]Doll R,Hill AB.The mortality of doctors in relation to their smoking habits:a preliminary report[J].Br Med J,1954,1(4877):1451-1455.DOI:10.1136/bmj.328.7455.1529.
[16]Colditz GA,Philpott SE,Hankinson SE.The impact of the Nurses’Health Study on population health:prevention,translation,and control[J].Am J Public Health,2016,106(9):1540-1545.DOI:10.2105/AJPH.2016.303343.
[17]Rimm EB,Stampfer MJ,Colditz GA,et al.Effectiveness of various mailing strategies among nonrespondents in a prospective cohort study[J].Am J Epidemiol,1990,131(6):1068-1071.
[18]Keyes KM,Galea S.Epidemiology matters:a new introduction to methodological foundations[M].USA:Oxford University Press,2014.
[19]Pizzi C,De Stavola B,Merletti F,et al.Sample selection and validity of exposure-disease association estimates in cohort studies[J].J Epidemiol Community Health,2011,65(5):407-411.DOI:10.1136/jech.2009.107185.
[20]Szklo M,Nieto FJ,Miller D.Epidemiology:beyond the basics[M].USA:Oxford University Press,2001.
[21]Zang EA,Wynder EL.Differences in lung cancer risk between men and women:examination of the evidence[J].J Natl Cancer Inst 1996,88(3-4):183-192.
[22]Carneiro I,Howard N.Introduction to epidmeiology(Second edition)[M].UK:Open University Press,2011.
[23]Schulz KF,Grimes DA.Case-control studies:research in reverse[J].Lancet,2002,359(9304):431-434.
[24]Kopec JA,Esdaile JM.Bias in case-control studies.A review[J].J Epidemiol Community Health,1990,44(3):179-186.
[25]Wacholder S,Mc Laughlin JK,Silverman DT,et al.Selection of controls in case-control studies.I.Principles[J].Am J Epidemiol,1992,135(9):1019-1028.
[26]Wacholder S,Silverman DT,Mc Laughlin JK,et al.Selection of controls in case-control studies.II.Types of controls[J].Am JEpidemiol.1992,135(9):1029-1041.
[27]Frieden TR.Evidence for health decision making-beyond randomized,controlled trials[J].N Engl J Med,2017,377(5):465-475.DOI:10.1056/NEJMra1614394.
[28]Stuart EA,Bradshaw CP,Leaf PJ.Assessing the generalizability of randomized trial results to target populations[J].Prev Sci,2015,16(3):475-485.DOI:10.1007/s11121-014-0513-z.
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